Cardiovascular, obstetric and neonatal outcomes in women with previous fontan repair.

OBJECTIVES: To determine cardiovascular, obstetric and neonatal outcomes of pregnancies in women who have a Fontan circulation. METHODS: A retrospective case note review of all women with a Fontan circulation who attended the joint obstetric cardiac antenatal clinic at St Mary's Hospital, Manchester (UK) between 2004 and 2016 was performed. RESULTS: In total, there were 19 pregnancies in 9 women with a history of Fontan repair. 23 women with univentricular physiology attended in this time period. 10 pregnancies (53%) resulted in live births; 1 in a stillbirth at 31 weeks gestation and 8 in miscarriage. Cardiovascular complications occurred in 2 pregnancies (11%). There were no thrombotic events, arrhythmias, myocardial infarction, or endocarditis in the antenatal or postnatal period. Obstetric complications included miscarriage (26% first trimester, 16% second trimester), along with premature delivery (24-36+6) (80%) and fetal growth restriction (70%). The majority of women were delivered by caesarean section (60%). CONCLUSIONS: Women who become pregnant following a Fontan repair carry an increased risk of cardiovascular complications. Fetal and neonatal complication rates are high and emphasize the importance of thorough, multidisciplinary, pre-conceptual assessment and counseling to allow patients to make informed decisions regarding future pregnancy.

Sequential changes in alanine metabolism following partial hepatectomy in the rat.

After partial hepatectomy, the liver undergoes an array of metabolic changes until regeneration is complete. Since carbons derived from alanine can be incorporated into most metabolic pools, we studied the metabolism of (14)C-labeled alanine during the early phase of regeneration. Sham operated (controls) and partially hepatectomized rats weighing about 200 g each were injected intraperitoneally with 1-[U-(14)C]alanine at 9, 18, and 36 hours after surgery. The animals were killed 2 hours after injection. Compared to the controls, alanine oxidation was markedly depressed (P < 0.05) in the 9- and 18-hour groups, but was restored in the 36-hour group. The specific activity of plasma glucose and hepatic glycogen was elevated 9 and 18 hours after partial hepatectomy. There was a corresponding increase in the activities of fructose-1,6-diphosphatase and phosphoenolpyruvate carboxykinase. Hepatic protein specific activity increased by 30, 74, and 120%, respectively 9, 18, and 36 hours after partial hepatectomy. Hepatic fatty acids followed a similar pattern. In a separate set of experiments, the distribution of radioactivity in glutamic acid was measured. The results showed that alanine carbons enter the citric acid cycle primarily via the acetyl CoA pathway in the controls, but via the oxaloacetate pathway in partially hepatectomized rats. The results demonstrate significant changes in the activities of metabolic pathways of alanine in the early phase of hepatic regeneration.

An extension of the Cormack-Jolly-Seber model for continuous covariates with application to Microtus pennsylvanicus.

Recent developments in the Cormack-Jolly-Seber (CJS) model for analyzing capture-recapture data have focused on allowing the capture and survival rates to vary between individuals. Several methods have been developed in which capture and survival are functions of auxiliary variables that may be discrete, constant over time, or apply to the population as a whole, but the problem has not been solved for continuous covariates that vary with both time and individual. This article proposes a new method to handle such covariates by modeling changes over time via a diffusion process and using logistic functions to link the variable to the CJS capture and survival rates. Bayesian methods are used to estimate the model parameters. The method is applied to study the effect of body mass on the survival of the North American meadow vole, Microtus pennsylvanicus.

Metabolic alterations induced by topical dimethylacetylenedicarboxylate.

The disposition of topical dimethylacetylenedicarboxylate (DMAD) in tissue and its effect on glucose metabolism were studied in vivo, using skin grafted athymic nude mice, and in vitro, using excised pig skin. [14C]DMAD that penetrated skin grafts was distributed throughout the body. At 24 hr, the liver contained 15.62% of the applied dose. The kidneys, lungs, brain, and the heart contained 12.73, 5.61, 0.36, and 3.24% of the dose, respectively. One hour postapplication, DMAD markedly decreased [U-14C]glucose oxidation and the syntheses of fatty acids and glycogen in the livers and skin grafts. Similar effects were observed in excised pig skin. In addition, the activities of hepatic glucose-6-phosphate dehydrogenase, isocitric and NADP-malic dehydrogenase, and acetyl-CoA carboxylase were significantly reduced in DMAD-treated mice. In contrast, no effect was observed on the activity of glucokinase. The data indicate that DMAD rapidly penetrates the skin and causes aberrations in the activities of the glycogenic, lipogenic, and tricarboxylic acid metabolic pathways.